Adjunctive Cerebrolysin therapy following mechanical thrombectomy for tandem right internal carotid artery and middle cerebral artery occlusion with residual post-procedural perfusion deficit: a case report.

Acute ischemic stroke patients may demonstrate persistent tissue-level hypoperfusion despite successful angiographic recanalization after mechanical thrombectomy. We report a 57-year-old man with wake-up stroke due to tandem occlusion of the right internal carotid artery and M1 middle cerebral artery who presented with left hemiparesis, neglect, and dysarthria (National Institutes of Health Stroke Scale, NIHSS, score 7). Computed tomography perfusion showed salvageable penumbral tissue, and he underwent mechanical thrombectomy with carotid stenting, achieving complete angiographic recanalization (Thrombolysis in Cerebral Infarction grade 3); no intravenous thrombolysis was given. However, post-procedural CT perfusion revealed persistent residual hypoperfusion despite macrovascular reperfusion. Adjunctive Cerebrolysin therapy was initiated immediately after the procedure. The patient demonstrated rapid neurological improvement (NIHSS 1 within hours), without treatment-related adverse effects, and was discharged on hospital day 5 with mild residual cognitive deficits. This case highlights the dissociation between angiographic and tissue-level reperfusion after thrombectomy and supports further investigation of adjunctive cerebroprotective strategies guided by post-procedural perfusion imaging. Registered at ClinicalTrials.gov (NCT06070753).